Healthcare Provider Details

I. General information

NPI: 1457664062
Provider Name (Legal Business Name): PAUL ISAAC CAMPOS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2010
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 W NOBLE AVE
VISALIA CA
93277-8354
US

IV. Provider business mailing address

5127 W NOBLE AVE
VISALIA CA
93277-8354
US

V. Phone/Fax

Practice location:
  • Phone: 559-713-6515
  • Fax: 559-713-6516
Mailing address:
  • Phone: 559-713-6515
  • Fax: 559-713-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: